Gonorrhea – sexually transmitted infections that cause damage to the mucous membranes of the organs lined with cylindrical epithelium: urethra, uterus, rectum, pharynx, conjunctiva of the eyes. It belongs to the group of sexually transmitted infections (STIs), the causative agent is gonococcus. It is characterized by mucous and purulent discharge from the urethra or vagina, pain and discomfort during urination, itching and discharge from the anus. With the defeat of the pharynx – inflammation of the throat and tonsils. Untreated gonorrhea in women and men causes inflammatory processes in the pelvic organs, leading to infertility; gonorrhea during pregnancy leads to infection of the child during childbirth.
Gonorrhea (tripper) is a specific infectious-inflammatory process, affecting mainly the urogenital system, which is caused by gonococci (Neisseria gonorrhoeae). Gonorrhea is a venereal disease, as it is transmitted mainly through sexual contact. Gonococci die quickly in the environment (when heated, dried, treated with antiseptics, under direct sunlight). Gonococci mainly affect the mucous membranes of organs with cylindrical and glandular epithelium. They can be located on the cell surface and intracellularly (in leukocytes, trichomonads, epithelial cells), can form L-forms (not sensitive to the effects of drugs and antibodies).
At the site of the lesion there are several types of gonococcal infection:
- gonorrhea urinary organs;
- gonorrhea of the anorectal region (gonococcal proctitis);
- gonorrhea of the musculoskeletal system (gonarthritis);
- gonococcal infection of the conjunctiva of the eye (blenorrhea);
- gonococcal pharyngitis.
Gonorrhea from the lower parts of the urogenital system (urethra, periuretal glands, cervical canal) can spread to the upper (uterus and appendages, the peritoneum). Gonorrheal vaginitis almost never occurs, as the squamous epithelium of the vaginal mucosa is resistant to the effects of gonococci. But with some mucosal changes (in girls, in women during pregnancy, in menopause), its development is possible.
Gonorrhea is more common among young people aged 20–30, but can occur at any age. The risk of gonorrhea complications is very high – various urinary disorders (including sexual disorders), infertility in men and women. Gonococci can penetrate the blood and, circulating throughout the body, cause damage to the joints, sometimes gonorrheal endocarditis and meningitis, bacteremia, severe septic conditions. Fetus infection from a mother infected with gonorrhea during labor is noted.
When symptoms of gonorrhea are erased, patients aggravate the course of their illness and spread the infection further, not knowing about it.
Gonorrhea is a highly contagious infection, in 99% it has a sexual transmission. Infection with gonorrhea occurs in various forms of sexual intercourse: vaginal (normal and incomplete), anal, oral.
In women after sexual intercourse with a sick man, the likelihood of contracting gonorrhea is 50-80%. Men who have sex with a woman with gonorrhea are not always infected – in 30-40% of cases. This is due to some anatomical and functional features of the genitourinary system in men (narrow canal of the urethra, gonococci can be washed off with urine.) Men are more likely to contract gonorrhea if the woman has menstruation, sexual intercourse is lengthened and has rapid completion.
Sometimes there can be a contact way of infecting a child from a mother suffering from gonorrhea during labor and household, indirect – through personal hygiene items (bed linen, washcloth, towel), usually in girls.
The incubation (hidden) period for gonorrhea can last from 1 day to 2 weeks, less often up to 1 month.
Infection with gonorrhea of a newborn baby
Gonococci cannot penetrate the intact membranes during pregnancy, but the premature rupture of these membranes leads to infection of the amniotic fluid and fetus. Infection with gonorrhea of a newborn can occur when passing through the birth canal of a sick mother. The conjunctiva of the eye is also affected, and the girls also have genitals. In half of cases, blindness in newborns is caused by infection with gonorrhea.
Symptoms of gonorrhea
Based on the duration of the disease, fresh gonorrhea is distinguished (from the moment of infection for 2 months).
Fresh gonorrhea can occur in acute, subacute, oligosymptomatic (torpid) forms. There is gonokokonositelstvo, which is not subjectively manifested, although the causative agent of gonorrhea is present in the body.
Currently, gonorrhea does not always have typical clinical symptoms, as it is often detected mixed infection (with trichomonads, chlamydia), which can change the symptoms, lengthen the incubation period, complicate the diagnosis and treatment of the disease. There are many less symptomatic and asymptomatic cases of gonorrhea.
Classical manifestations of the acute form of gonorrhea in women:
- purulent and sero-purulent vaginal discharge;
- hyperemia, edema and ulceration of the mucous membranes;
- frequent and painful urination, burning, itching;
- intermenstrual bleeding;
- lower abdominal pain.
In more than half of cases, gonorrhea in women occurs either sluggishly, with no symptoms, or does not appear at all. In this case, a late visit to a doctor is dangerous by the development of an ascending inflammatory process: gonorrhea affects the uterus, fallopian tubes, ovaries, peritoneum. The general condition may worsen, the temperature may rise (up to 39 ° C), menstrual disorders, diarrhea, nausea, and vomiting are observed.
In girls, gonorrhea has an acute course, is manifested by edema and hyperemia of the mucous membrane of the vulva and vestibule, burning and itching of the genitals, the appearance of purulent discharges, pain during urination.
Gonorrhea in men occurs mainly in the form of acute urethritis:
- itching, burning, swelling of the urethra;
- plentiful purulent, serous-purulent discharge;
- frequent painful, sometimes difficult urination.
In ascending type of gonorrhea, the testicles, prostate, seminal vesicles are affected, the temperature rises, chills occur, painful defecation occurs.
Gonococcal pharyngitis may manifest as redness and sore throat, fever, but more often it is asymptomatic. When gonococcal proctitis can be observed discharge from the rectum, pain in the anus, especially during defecation; although usually the symptoms are little pronounced.
Chronic gonorrhea has a protracted course with occasional exacerbations, manifested by adhesive processes in the pelvis, decreased sexual desire in men, menstrual disorders and reproductive function in women.
Complications of gonorrhea
Asymptomatic cases of gonorrhea are rarely detected at an early stage, which contributes to the further spread of the disease and gives a high percentage of complications.
Ascending infections in women with gonorrhea are promoted by menstruation, surgical abortion, diagnostic procedures (curettage, biopsy, probing), the introduction of intrauterine devices. Gonorrhea affects the uterus, fallopian tubes, ovarian tissue until the appearance of abscesses. This leads to disruption of the menstrual cycle, the occurrence of adhesions in the tubes, the development of infertility, and ectopic pregnancy. If a woman with gonorrhea is pregnant, the probability of spontaneous miscarriage, premature birth, infection of the newborn and the development of septic conditions after childbirth is high. When infected with gonorrhea of newborns, they develop inflammation of the conjunctiva of the eye, which can lead to blindness.
A serious complication of gonorrhea in men is gonococcal epididymitis, impaired spermatogenesis, a decrease in the ability of spermatozoa to fertilize.
Gonorrhea can pass to the bladder, ureters and kidneys, the pharynx and rectum, affect the lymph glands, joints, and other internal organs.
You can avoid unwanted complications of gonorrhea, if you start treatment in a timely manner, strictly observe the venereologist’s prescriptions, and lead a healthy lifestyle.
Diagnosis of gonorrhea
To diagnose gonorrhea, the presence of clinical symptoms in a patient is not enough, it is necessary to identify the causative agent of the disease using laboratory methods:
- examination of smears with the material under the microscope;
- bakposev material on specific nutrient medium to highlight pure culture;
- ELISA and PCR diagnostics.
In microscopy of smears stained by Gram and methylene blue, gonococci are determined by the typical bean-shaped shape and pairing, gram-negative and intracellular position. The causative agent of gonorrhea is not always possible to detect this method because of its variability.
In the diagnosis of asymptomatic forms of gonorrhea, as well as in children and pregnant women, a more suitable method is cultural (its accuracy is 90-100%). The use of selective media (blood agar) with the addition of antibiotics makes it possible to accurately identify even a small amount of gonokokkov and their sensitivity to drugs.
The material for research on gonorrhea is purulent discharge from the cervical canal (in women), urethra, lower rectum, oropharynx, conjunctiva of the eyes. In girls and women after 60 years using only the cultural method.
Gonorrhea often occurs as a mixed infection. Therefore, a patient with suspicion of gonorrhea is also examined for other STIs. Anti-hepatitis B and C antibodies are tested for HIV, serological reactions for syphilis, general and biochemical analysis of blood and urine, ultrasound of the pelvic organs, urethroscopy, in women – colposcopy, cytology of the mucous membrane of the cervical canal.
Examinations are carried out before the start of treatment for gonorrhea, again 7-10 days after treatment, serological tests – after 3-6-9 months.
The need to use provocations for the diagnosis of gonorrhea, the doctor decides in each case individually.
Self-treatment of gonorrhea is unacceptable, it is dangerous for the disease to become chronic, and the development of irreversible lesions of the body. All sexual partners of patients with symptoms of gonorrhea who have had sexual contact with them for the last 14 days, or the last sexual partner, should be examined and treated if the contact occurred earlier than this period. In the absence of clinical symptoms in a patient with gonorrhea, all sexual partners are examined and treated in the last 2 months. For the period of treatment of gonorrhea, alcohol and sex are excluded; during the period of follow-up, sexual intercourse using a condom is permitted.
Modern venereology is armed with effective antibacterial drugs that can successfully fight gonorrhea. In the treatment of gonorrhea, the duration of the disease, the symptoms, the location of the lesion, the absence or presence of complications, and the associated infection are taken into account. In acute ascending type of gonorrhea, hospitalization, bed rest, therapeutic measures are necessary. In the event of purulent abscesses (salpingitis, pelvioperitonitis), emergency surgery is performed – laparoscopy or laparotomy. The main place in the treatment of gonorrhea is given to antibiotic therapy, while taking into account the resistance of some strains of gonococci to antibiotics (for example, penicillins). With the ineffectiveness of the antibiotic used, another drug is prescribed, taking into account the sensitivity of the gonorrhea pathogen to it.
The urogenital gonorrhea is treated with the following antibiotics: ceftriaxone, azithromycin, cefixime, ciprofloxacin, spectinomycin. Alternative treatment regimens for gonorrhea include the use of ofloxacin, cefozidime, kanamycin (in the absence of hearing disorders), amoxicillin, trimethoprim.
Fluoroquinolones are contraindicated in children under 14 years of age in the treatment of gonorrhea, tetracyclines, fluoroquinolones, and aminoglycosides to pregnant women and nursing mothers. Antibiotics that do not affect the fetus (ceftriaxone, spectinomycin, erythromycin) are prescribed, prophylactic treatment of newborns in mothers of patients with gonorrhea (ceftriaxone intramuscularly, washing the eyes with silver nitrate solution or laying erythromycin eye ointment) is carried out
Treatment of gonorrhea can be adjusted if there is a mixed infection. In torpid, chronic and asymptomatic forms of gonorrhea, it is important to combine the main treatment with immunotherapy, topical treatment and physiotherapy.
Local treatment of gonorrhea includes the introduction into the vagina, the urethra 1-2% p-ra protorgol, 0.5% p-ra silver nitrate, microclysters with chamomile extract. Physiotherapy (electrophoresis, ultraviolet irradiation, UHF currents, magnetic therapy, laser therapy) is used in the absence of an acute inflammatory process. Immunotherapy for gonorrhea is prescribed without exacerbation to increase the level of immune reactions and is divided into specific (gonovacin) and nonspecific (pyrogenal, autohemotherapy, prodigiosan, levamiozole, methyluracil, glycers, etc.). Children under 3 years of immunotherapy is not carried out. After treatment with antibiotics, lacto- and bifidopreparations are prescribed (oral and intravaginal).
The successful outcome of gonorrhea treatment is the disappearance of the symptoms of the disease and the absence of the pathogen according to the results of laboratory tests (7-10 days after the end of treatment).
At present, the need for various types of provocations and numerous follow-up examinations after the end of treatment for gonorrhea, conducted by modern highly effective antibacterial drugs, is being challenged. We recommend one patient follow-up examination to determine the adequacy of this treatment for gonorrhea. Laboratory monitoring is prescribed, if clinical symptoms remain, there are relapses of the disease, re-infection with gonorrhea is possible.
Prevention of gonorrhea
Prevention of gonorrhea, like other STDs, includes:
- personal prophylaxis (excluding casual sex, condom use, personal hygiene);
- timely detection and treatment of patients with gonorrhea, especially in risk groups;
- professional examinations (for employees of children’s institutions, medical personnel, workers in the sphere of nutrition);
- compulsory examination of pregnant women and management of pregnancy.
In order to prevent gonorrhea, a solution of sulfacyl sodium is instilled into the eyes of a newborn immediately after birth.